Does operative experience during residency correlate with reported competency of recent general surgery graduates

Surgical residency must prepare future general surgeons for a variety of professional experiences, ranging from subspecialty practice in urban centres to general surgical practice in rural communities in which the full complement of surgical specialty coverage may be lacking. Canadian data on the distribution of general surgeons by practice type include the 2011 Canadian Association of General Surgeons (CAGS) survey in which 19% of 335 respondents identified their practices as “community” in type.1 The 2009 CAGS survey identified 14% of respondents as practising in a community with a population of 50 000 or fewer, whereas 47% of respondents worked in centres with a population of 500 000 or more.2 Depending on the specific needs of a surgical practice and the operative expertise acquired during residency, newly trained surgeons may feel variably prepared for their professional roles. Kaminsky and colleagues3 reported that most Canadian residents in their final year of training expressed confidence with basic general surgical procedures, including laparoscopic cholecystectomy, appendectomy, mesh hernia repair, simple mastectomy and hemor-rhoidectomy, yet expressed a lack of confidence in their ability to perform procedures that are often required in rural jurisdictions, including gynecological, genitourinary and orthopedic surgery. The same appears to be true for advanced laparoscopic procedures, with less than 25% of Canadian-trained residents reporting feeling comfortable performing laparoscopic splenectomy, Heller myotomy, fundoplication and adrenalectomy.4 Hence, Canadian general surgical training programs face a challenge in producing graduates whose acquired skills during residency result in self-perceived competence during early professional practice. Despite formalization of surgical curricula and the establishment of CanMEDS training competencies,5 it seems likely that gaps exists between competencies achieved during residency and competencies required across the spectrum of Canadian general surgical practice. In recognition of the diversity of expertise required by Canadian general surgeons and of the critical need for general surgeons in community-based practice,6 the present study sought to compare the educational and technical skills acquired during residency with the skill set requirements perceived by recent general surgical graduates of 2 western Canadian general surgical training programs.